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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Laparoscopy was performed in 223 patients with acute pelvic pain but without a definite diagnosis. The clinically suspected diagnosis was confirmed by laparoscopy in only 57 patients (25%). Laparotomy was thus avoided in 145 patients (65%). The endoscopic findings in the three clinical entities included here are presented: tubal pregnancy, acute appendicitis or torsion of adnexal mass. This study emphasizes the poor correlation between the clinical diagnosis based on history, pelvic examination and physical signs, and the final laparoscopic findings. The value of laparoscopy in evaluation of acute pelvic disease is stressed.
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PMID:The value of laparoscopy in acute pelvic pain. 12 58

Paper concerns 1822 performed laparoscopies. The most frequent indications to laparoscopy were: sterility, adnexal mass, tubal pregnancy and pelvic pain syndrome. In 80% cases of sterility we found pathologic findings, which could be the cause of sterility. adnexal mass, tubal pregnancy and pelvic pain syndrome. In 80% cases of sterility we found pathologic findings, which could be the cause of sterility. In 75% of cases we confirmed adnexal mass, which were operated by laparoscopy or by laparotomy. In 17 cases we confirmed unruptured tubal pregnancy, which were conservatively operated by laparoscopy or by laparotomy. Laparoscopy is useful method in gynecology, especially in diagnostically difficult cases of gynecologic disease.
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PMID:[Use of laparoscopy in gynecology]. 130 79

We performed a prospective study to evaluate the reliability of a rapid monoclonal antibody urine pregnancy test with a sensitivity limit of 20 mIU/mL combined with transvaginal ultrasonography in the early diagnosis of ectopic pregnancy in 116 women with subacute pelvic pain and a stable general condition. The diagnosis of tubal pregnancy was confirmed with laparoscopy in 100 of the 103 women with positive sensitive urine pregnancy tests and no intrauterine gestational sac at transvaginal ultrasonography. Laparoscopy revealed a hemorrhagic corpus luteum in four of the eight subjects with negative monoclonal antibody pregnancy tests and no intrauterine gestational sac, an ovarian cyst in three and a normal pelvis in one. Of the five women with a positive pregnancy test and an intrauterine gestational sac, two had a hemorrhagic corpus luteum, two a normal pelvis and one a tubal pregnancy at laparoscopy. The sensitivity of a monoclonal antibody urine pregnancy test and transvaginal ultrasonography combined for the diagnosis of ectopic pregnancy was 99%, and the specificity was 80%, with positive and negative predictive values of 97% and 92%, respectively.
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PMID:Early detection of ectopic pregnancy. Use of a sensitive urine pregnancy test and transvaginal ultrasonography. 194 85

Used endoscopically, the CO2 laser offers some advantages over other operative techniques for endometriosis and adhesions but, in spite of the continuing development of new instrumentation there are still problems with the system. The technique needs specialized equipment requiring ongoing biomedical maintenance and specialized technical care in the operating room. Some problems such as the intraperitoneal accumulation of smoke, gas leakage, and difficulty with maintenance of proper beam alignment still occur. In spite of these problems the advantages are numerous: the system allows precise bloodless destruction of diseased tissue and eliminates the risks of cautery. In the hands of an experienced laparoscopist, it appears safe and effective in vaporization of endometriotic lesions, utero-sacral neurectomy, adhesiolysis and salpingostomy. The judicious use of these techniques, combined with carefully planned further investigations by well-trained and experienced laparoscopists and continuing improvements in the delivery systems, will soon reveal the true efficacy of the CO2 laser laparoscope. If studies continue to show pregnancy rates and pain relief to be equivalent to those patients treated by laparotomy, CO2 laser laparoscopy will become the preferred procedure for the management of pelvic endometriosis and its associated adhesions, distal tubal occlusion, pelvic pain and tubal pregnancy. With the exception of using the argon laser to treat endometriosis, the selective absorption characteristic of lasers has not been greatly utilized. While the CO2 laser is heavily absorbed by water and hence vaporizes most cells in a rather indiscriminate fashion, this is not true for other wavelengths, such as argon, Nd-YAG, KTP, krypton, xenon, copper and gold vapour lasers. The energy form of each of these lasers has different properties of penetration, absorption, reflection and heat dissipation. Many of these lasers have not yet been evaluated in human subjects. An exciting, although not new, area of possible laser application involves the use of photosensitizers and fluorescing agents (Dougherty et al, 1978). Some recent experimental studies (Schellhas and Schneider, 1986; Schneider et al, 1988) may lead to new therapeutic possibilities. The surgical laser is not, however, a panacea. Only controlled trials carried out carefully over the next few years will clearly define its potential. In the meantime it is incumbent upon all of us to investigate the clinical, gynaecological and surgical applications in a careful, methodical and scientific manner.
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PMID:CO2 laser laparoscopic surgery. Adhesiolysis, salpingostomy, laser uterine nerve ablation and tubal pregnancy. 253 9

A case of tubal pregnancy in a young and healthy woman participating in a programme of in-vitro fertilization (IVF) gestational surrogacy is reported. The gestational surrogate was the 30 year old fertile sister of a 25 year old patient affected by stage 1 ovarian cancer. After mandatory oncological consultation, the donor was recommended to prospectively undergo controlled ovarian hyperstimulation cycles for embryo banking before being treated by total hysterectomy. Available embryos were cryopreserved and after adequate endometrial preparation using artificial cycles of hormone replacement therapy, three thawed frozen embryos were transferred to the surrogate. At 17 days following embryo transfer the surrogate was noted to have a negative beta-human chorionic gonadotrophin (HCG) serum concentration. All medication was suspended and a few days later normal menstrual bleeding occurred. After 2 weeks, the beta-HCG concentrations, performed as part of routine follow-up evaluation, were showing signs of trophoblast activity (236 mIU/ml). Taking into account the stable condition of the patient, a decision was made to undertake expectant management. At 43 days after embryo transfer, a complete tubal abortion was apparently seen in the posterior cul-de-sac by ultrasound associated with a subtle and short lasting pelvic pain. We stress that this ectopic gestation was able to maintain prolonged viability in conditions of absent corpus luteum and exogenous steroid supplementation.
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PMID:Spontaneous resolution of ectopic pregnancy in a surrogate after oocyte donation and frozen embryo transfer. 902 91

A 24-year-old woman, HIV seropositive, LMP ten weeks previously, para 2-0-0-2, presented with complaints of left sided pelvic pain. Her previous pregnancies were terminated by cesarean section with tubal sterilization (Pomeroy technique) in the first pregnancy and by cesarean section with repeated tubal sterilization (Pomeroy technique) in the second one. The pelvic examination revealed cervical motion tenderness and a tender sausage-like mass of about 3 x 4 cm in the left adnexa. Both previously ligated fallopian tubes and a hematosalpinx lying distal to the ligated site of the left tube were revealed in the exploratory laparotomy after a positive culdocentesis. Bilateral salpingectomy was performed. The histological examination confirmed the diagnosis of tubal pregnancy in the left tube and the status post tubal sterilization in the right one. The postoperative course was uneventful.
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PMID:Intra- and extra-uterine pregnancies following repeated sterilization in a case of HIV seropositive patient. 1065 73

The authors describe the case of a right tubal pregnancy of delayed diagnosis in a 31-year-old nullipara, who was submitted to voluntary termination during the 7th week of pregnancy and who presented a homolateral ovarian cyst. Two weeks later the patient presented pelvic pain and intraperitoneal fluid layer, while plasma beta-hCG was 1,262 IU/ml. The case history was complicated by recent termination surgery and presence of an ovarian cyst, but a plasma beta-hCG assay and transvaginal ultrasonography oriented the diagnosis towards a previously unrevealed heterotopic pregnancy. The fallopian tube and the ovarian cyst were removed by laparoscopy. The case points out to the fact that, though rare, heterotopic pregnancy must always be considered one of the possible complications of spontaneous pregnancy.
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PMID:Coexistence of a heterotopic pregnancy associated with a homolateral ovarian cyst in a patient submitted to elective abortion. 1082 14

The development of gynecology as a specialty, although primarily American in origin, was influenced in large degree by Robert Lawson Tait, a brilliant Scottish/English surgeon who practiced in the late 19th century. Tait, a self-proclaimed gynecologist, is perhaps most widely known as the first to perform salpingectomy to treat ruptured tubal pregnancy. He was also the first to record removal of an ovary for relief of pelvic pain and to induce menopause, perform salpingectomy for the treatment of tubal disease, and develop the technique of transverse transperineal repair of low rectovaginal fistulas. His scrupulous cleanliness was undoubtedly the forerunner of our modern aseptic methods. Tait's bold, innovative surgical techniques led to a significant decrease in surgical mortality, and his prescient, aggressive approach was at the forefront of changes in the practice of obstetrics, which resulted in a marked decrease in maternal morbidity and mortality. This master teacher, whose contributions inspired the next great generation of abdominal and pelvic surgeons, deserves greater recognition within our specialty.
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PMID:Lawson Tait: the forgotten gynecologist. 1177 26

Chlamydia trachomatis infection is the most commonly reported sexually transmitted disease (STD) in the United States. An estimated 2.8 million infections occur annually. In 2002, a total of 834,555 cases in the United States, including 10,914 cases in Massachusetts, were reported through the National Notifiable Disease Surveillance System (NNDSS). Chlamydial infection is most often reported in females, particularly those aged 15-24 years, reflecting a higher level of screening in females but also important risk factors. Although the majority of infections are asymptomatic, complications are potentially severe in women and include pelvic inflammatory disease, which can lead to tubal pregnancy, infertility, and chronic pelvic pain. Chlamydial infection during pregnancy can cause illness in the infant (e.g., conjunctivitis and pneumonia). Infection in men can manifest as urethritis and epididymitis. Timely, documented diagnosis and treatment of chlamydial infection are critical to prevent both complications and transmission. Since 1996, a progressive increase has occurred in the number of reported cases of chlamydial infection in Massachusetts, in part because of an increase in screening and use of more sensitive tests. This report summarizes an evaluation of chlamydial-infection reporting in Massachusetts during January-June 2003. The results underscore the need for improvement in both completeness and timeliness of reporting chlamydial infection in Massachusetts.
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PMID:Reporting of chlamydial infection--Massachusetts, January-June 2003. 1594 26

This chapter summarizes the diagnostic performance (sensitivity, specificity, positive and negative likelihood ratios) of ultrasound, computer tomography, and magnetic resonance imaging in the diagnosis of various gynecological diseases and tumors. Positron emission tomography is not discussed. Imaging in infertility, in the diagnosis of Mullerian duct anomalies and in gynecological oncology (staging of gynecological cancers, diagnosis of recurrence of gynecological cancer, diagnosis of trophoblastic tumors) is not dealt with. Ultrasound is the first-line imaging method for discrimination between viable intrauterine pregnancy, miscarriage and tubal pregnancy in women with bleeding and/or pain in early pregnancy, for discrimination between benign and malignant adnexal masses and for making a specific diagnosis in adnexal tumors (e.g. dermoid cyst, endometrioma, hemorrhagic corpus luteum, etc.), for diagnosing intracavitary uterine pathology in women with bleeding problems, and for confirming or refuting pelvic pathology in women with pelvic pain. Magnetic resonance imaging can have a role as a secondary test in the diagnosis of adenomyosis, 'deep endometriosis' (e.g. endometriosis in the rectovaginal septum or in the uterosacral ligaments), and in the diagnosis of extremely rare types of ectopic pregnancy (e.g. in the spleen, liver or retroperitoneum).
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PMID:Imaging in gynecology. 1690 42


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